Feldstein Adrianne C, Nichols Gregory, Orwoll Eric, Elmer Patricia J, Smith David H, Herson Michael, Aickin Mikel
Center for Health Research, Kaiser Permanente, Portland, OR 97227-1110, USA.
Osteoporos Int. 2005 Aug;16(8):953-62. doi: 10.1007/s00198-005-1950-0. Epub 2005 Jun 1.
The burden of osteoporotic fractures in older men is significant. The objectives of our study were to: (1) characterize older men with fractures associated with osteoporosis, (2) determine if medication treatment rates for osteoporosis are improving and (3) identify patient, healthcare benefit and utilization, and clinician characteristics that are significantly associated with treatment. This retrospective cohort study assessed 1,171 men aged 65 or older with any new fracture associated with osteoporosis between 1 January 1998 and 30 June 2001 in a non-profit health maintenance organization in the United States. Multiple logistic regression was used to evaluate pre-fracture factors for their association with osteoporosis treatment in the 6-month post-fracture period. The main outcome measure was pharmacologic treatment for osteoporosis in the 6 months after the index fracture. Subjects' average age was 76.7 years; 3.3% had a diagnosis of osteoporosis and 15.2% a diagnosis or medication associated with secondary osteoporosis. Only 7.1% of the study population and 16.0% of those with a hip or vertebral fracture received a medication for osteoporosis following the index fracture, and treatment rates did not improve over time. In the multivariate model, factors significantly associated with drug treatment were a higher value on the Charlson Comorbidity Index (odds ratio 1.26, 95% confidence interval 1.05-1.51), having an osteoporosis diagnosis (odds ratio 8.11, 95% confidence interval 3.08-21.3), chronic glucocorticoid use (odds ratio 5.37, 95% confidence interval 2.37-12.2) and a vertebral fracture (odds ratio 16.6, 95% confidence interval 7.8-31.4). Bone mineral density measurement was rare (n =13, 1.1%). Our findings suggest that there is under-ascertainment and under-treatment of osteoporosis and modifiable secondary causes in older men with fractures. Information systems merging diagnostic and treatment information can help delineate gaps in patient management. Interventions showing promise in other conditions should be evaluated to improve care for osteoporosis.
老年男性骨质疏松性骨折的负担很重。我们研究的目的是：（1）描述患有与骨质疏松症相关骨折的老年男性的特征，（2）确定骨质疏松症的药物治疗率是否正在提高，以及（3）确定与治疗显著相关的患者、医疗保健益处和利用率以及临床医生特征。这项回顾性队列研究评估了1998年1月1日至2001年6月30日期间在美国一家非营利性健康维护组织中1171名65岁及以上患有任何与骨质疏松症相关新骨折的男性。采用多因素逻辑回归来评估骨折前因素与骨折后6个月内骨质疏松症治疗的相关性。主要结局指标是指数骨折后6个月内骨质疏松症的药物治疗情况。受试者的平均年龄为76.7岁；3.3%被诊断为骨质疏松症，15.2%被诊断为或使用与继发性骨质疏松症相关的药物。在指数骨折后，研究人群中只有7.1%以及髋部或脊椎骨折患者中只有16.0%接受了骨质疏松症药物治疗，且治疗率并未随时间改善。在多变量模型中，与药物治疗显著相关的因素包括Charlson合并症指数较高（比值比1.26，95%置信区间1.05 - 1.51）、患有骨质疏松症诊断（比值比8.11，95%置信区间3.08 - 21.3）、长期使用糖皮质激素（比值比5.37，95%置信区间2.37 - 12.2）以及脊椎骨折（比值比16.6，95%置信区间7.8 - 31.4）。骨密度测量很少见（n = 13，1.1%）。我们的研究结果表明，患有骨折的老年男性中，骨质疏松症及可改变的继发性病因存在诊断不足和治疗不足的情况。合并诊断和治疗信息的信息系统有助于勾勒出患者管理中的差距。应评估在其他情况下显示有前景的干预措施，以改善骨质疏松症的治疗。
